Anytime Care 2020(Leicester)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff understood their role and responsibilities when incidents occurred. The registered manager shared examples of lessons learnt following reviews and investigations. These examples demonstrated that lessons learned were used effectively to improve practice. Including enhancing staff knowledge and competence and reducing the likelihood of similar incidents occurring in the future.

For example, actions were taken to reduce a person’s risk of falls through environmental assessments and changes to minimise future risks. Following a review of daily care records completed by staff, the registered manager identified a training need. This resulted in additional guidance and support being provided to staff to improve record-keeping quality.

Staff confirmed that communication processes were effective and described how lessons learned were shared with them. Records from staff meetings also demonstrated the registered manager's commitment to information sharing, reflective practice, and actions that supported a positive learning culture.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

The provider had systems in place to assess people's individual needs before care and treatment were delivered. Pre-assessments enabled the registered manager to identify specific health conditions, risks, and support requirements, including where staff required additional training or specialist guidance. However, identified needs were not always translated into effective care planning arrangements to ensure people received safe and consistent care.

For example, 1 person was living with a health condition that was monitored daily by community nursing services. Although this need had been identified during the assessment process, staff providing direct care had not received the necessary training, knowledge, or guidance to understand the person's condition or monitor their wellbeing appropriately during care visits. This meant staff may not have been able to recognise changes in the person's health, escalate concerns promptly, or communicate effectively with healthcare professionals, placing the person at risk of harm.

Staff training records identified further gaps in training linked to people’s assessed healthcare needs. This demonstrated that the provider’s systems and processes for ensuring safe care pathways and transitions were not effective, as they had failed to ensure staff possessed the necessary skills, knowledge, and competence to meet people’s needs safely. As a result, the provider could not be assured that people’s health conditions were consistently understood, monitored, and responded to appropriately, or that information and support were effectively coordinated across services to maintain continuity of care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt care staff provided safe care.

People were protected as far as possible from abuse and avoidable harm. Staff received annual safeguarding training and had access to the provider’s safeguarding policy and knew how to recognise and report safeguarding concerns. A staff member said, “Safeguarding is about making sure that we meet the persons every need and to consistently check for any risks, change to the person's needs or any incidents that have occurred, if anything is amiss, we assess, record and report to the management team as soon as possible.”

The provider’s service user guide provided people with information about what they could expect from the service, and this included information about safeguarding. This included guidance of what this means and how to report any safeguarding concerns.

At the time of the inspection, no person using the service had a Community Deprivation of Liberty Safeguard (DoLS) in place that imposed restrictions on them for their safety.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks had been assessed and plans were in place to guide staff in supporting people safely. However, we found some aspects of the risk management documentation lacked sufficient detail about the specific actions staff should take to manage and mitigate identified risks. These inconsistencies, and in some cases a lack of information, increased the risk of people receiving unsafe or inappropriate care. Whilst some risk assessment recorded who and how staff were to report concerns to, others did not. This inconsistency could result in delays in escalation and decision-making, potentially impacting the timely management of risks.

For example, 1 person had a diagnosis of type 1 diabetes. However, risks associated with this condition, including hypoglycaemia (low blood glucose levels) and hyperglycaemia (high blood glucose levels), had not been assessed or planned for within their care records. Another person's care records instructed staff to monitor for sepsis, a serious and potentially life-threatening condition, but did not provide guidance on the signs and symptoms staff should look for or the actions they should take if concerns arose.

This meant staff did not always have access to the information and guidance necessary to identify deteriorating health conditions, respond appropriately to emerging risks, or seek timely medical assistance. As a result, people were placed at increased risk of receiving unsafe care and treatment, and the provider could not be assured that risks to people's health and wellbeing were being managed consistently and effectively.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

An assessment of the environmental, premises, and equipment, including fire safety risks for both the person using the service and staff, had not been completed or adequately planned for. Whilst we saw examples of risk assessments that referred to ensuring there were no trip hazards within people's homes, this did not constitute a comprehensive assessment of environmental risks. This meant the provider could not be assured that all environmental and premises-related risks had been identified, assessed, and planned for. This compromised the safety of both staff and people.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

Overall, people told us staff were competent and had the skills required to support them. However, some people felt staff's understanding of dementia care could be improved. One person commented that staff did not always understand how to use domestic appliances when supporting them with meal preparation. We shared this feedback with the registered manager, who agreed to follow this up.

The provider had recruitment procedures in place. These checks were completed before staff commenced, ensuring only suitable candidates with the right skills and experience were appointed. However, some improvements were required to the provider’s systems and processes to ensure procedures were completed consistently.

Gaps in staff training were identified. This meant the provider could not assure themselves that staff had the knowledge and skills required to meet people’s assessed needs safely, increasing the risk of unsafe or inconsistent care. For example, staff had not received training in areas relevant to the needs of people they supported, including sepsis awareness, pressure care and skin integrity, end-of-life care, and diabetes management.

In addition, one person was receiving a delegated healthcare task that required staff to be trained and assessed as competent by an appropriate NHS healthcare professional. Records showed this training and competency assessment had not been completed. We raised this with the registered manager during the assessment, who took immediate action to address this concern.

We also found that not all staff had completed the mandatory training requirement relating to learning disability and autistic people. This meant the provider could not be assured that staff had received training in line with current legislative requirements and best practice guidance.

Whilst staff told us they felt well supported, some staff felt training could be increased. A staff member said, “The service could improve by increasing training opportunities.”

Staff received opportunities to discuss their work, training and development. Staff also received spot checks and observational assessments of their practice.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had received training in infection prevention and control (IPC). They had access to the provider’s policy and personal protective equipment (PPE). Guidance for staff about how to meet people’s care needs reflected infection prevention and control practice and requirements of staff.

The management team completed spot checks on staff to ensure they were providing care in line with expected care standards and the provider’s policies These records confirmed that checks on staff IPC practices were being conducted.

People confirmed staff wore appropriate PPE, including gloves, aprons and masks when required.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Two people's medicine care plans did not accurately reflect the information recorded on their Medicine Administration Record (MAR). This meant staff could be relying on inconsistent or outdated information when supporting the person with their medicines. The discrepancy increased the risk of medication errors, omissions, or staff not following the most current prescribing instructions, potentially compromising the safe management of medicines.

Prescribed topical creams did not have a body map used to show staff the site of application. The registered manager confirmed risk assessments were not completed for emollient creams. This is important due to the cream being paraffin based and therefore a fire risk. People’s preference of how they like to take their medicines was not recorded. These examples meant people could not be assured they were supported safely and effectively with their prescribed medicines.

The registered manager told us MARs were only used for people who were ‘assisted’ with their medicines and not if they were ‘prompted’. This practice was not in line with the National Institute for Health and Care Excellence (NICE) guidance NG67, that states a MAR is required for medicines support provided by staff. A lack of required record keeping compromised people’s health, safety and wellbeing.

Staff had received medicines training, and the provider completed medicines competency spot checks. However, these checks were not sufficiently detailed or robust to provide assurance that staff were competent to administer and manage medicines safely.

A person’s high-risk medicine had been risk assessed. However, staff were required to monitor for internal bleeding, but no guidance had been provided of the signs and symptoms that may indicate internal bleeding. This meant staff may not have been able to recognise potential indicators of internal bleeding promptly, which could have resulted in delays in seeking emergency medical assistance.

Medicine care plans did not consistently provide staff of information about the purpose of each medicine or any potential side effects to monitor for. Without this information, staff may not identify medicine-related concerns promptly, increasing the risk of delays in responding to changes in a person's health and wellbeing.